1
|
Malhotra P, Singh P, Kundu BK, Bhardwaj M. Non-bullous neutrophilic lupus erythematosus-Muted bullous disease? INDIAN J PATHOL MICR 2021; 63:305-308. [PMID: 32317541 DOI: 10.4103/ijpm.ijpm_704_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-bullous neutrophilic lupus erythematosus is a rare form of cutaneous lupus erythematosus (LE). We hereby present a case of 24-year-old female, known case of discoid LE (DLE) with negative ANA stabilized on hydroxychloroquine for 2 years. She reported new occurrence of erythematous, mildly pruritic, papular lesions and painful mucosal ulceration. The ANA became strongly positive by ELISA and urine showed proteinuria. A provisional diagnosis of Rowell syndrome was made, skin biopsy was taken, and patient started on steroids. Histopathology showed interface vacuolar change and many neutrophils in the dermis with leukocytoclasia without any bulla formation. The skin lesions responded promptly to addition of dapsone following biopsy report. We conclude that the presence of neutrophils associated with interface pathology on biopsy represents a muted form of bullous LE, especially in patients on immunosuppression. This case highlights the importance of histopathologic examination in the evaluation of any new skin lesions in a patient of lupus on therapy.
Collapse
Affiliation(s)
- Purnima Malhotra
- Department of Pathology, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Preeti Singh
- Department of Pathology, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Bijit K Kundu
- Department of Medicine, ABVIMS and Dr. RML Hospital, New Delhi, India
| | - Minakshi Bhardwaj
- Department of Pathology, ABVIMS and Dr. RML Hospital, New Delhi, India
| |
Collapse
|
2
|
Okamoto M, Hayashi S, Ikegami T, Kaminaga T, Hamasaki Y, Igawa K. Development of Sweet's syndrome and the immunological finding of systemic lupus erythematosus during the course of mixed connective tissue disease. Int J Dermatol 2020; 60:e107-e108. [PMID: 33040354 DOI: 10.1111/ijd.15241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/08/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Maki Okamoto
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Shujiro Hayashi
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Tetsuharu Ikegami
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Tomoko Kaminaga
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Yoichiro Hamasaki
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Ken Igawa
- Department of Dermatology, Dokkyo Medical University School of Medicine, Mibu, Japan
| |
Collapse
|
3
|
Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
Collapse
Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| |
Collapse
|
4
|
Hannah CE, Moye MS, Wanat KA, Liu V. Systemic lupus erythematosus‐associated neutrophilic dermatosis manifesting as an acneiform eruption and foot pain. Clin Exp Dermatol 2019; 44:801-803. [DOI: 10.1111/ced.13900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- C. E. Hannah
- University of Iowa Carver College of Medicine Iowa City IA USA
| | | | - K. A. Wanat
- Departments of Dermatology and Pathology University of Iowa Hospitals and Clinics Iowa City IA USA
| | - V. Liu
- Departments of Dermatology and Pathology University of Iowa Hospitals and Clinics Iowa City IA USA
| |
Collapse
|
5
|
Athanasopoulos E, Kalaitzidou I, Vlachaki G, Stefanaki S, Tzagkaraki A, Niotakis G, Tritou I, Ladomenou F. Chorea revealing systemic lupus erythematosus in a 13-year old boy: A case report and short review of the literature. Int Rev Immunol 2018; 37:177-182. [PMID: 29595356 DOI: 10.1080/08830185.2018.1452920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Among the neurological manifestations of systemic lupus erythematosus (SLE), chorea is rare, presenting in less than 7% of the pediatric SLE patients. It can appear early in the onset of SLE, be the first or even the sole clinical feature of the illness and has strongly been associated with the presence of antiphospholipid antibodies. We report on the case of a 13-year old boy, admitted with acute onset chorea and finally diagnosed with SLE. Subsequently, we present a short review of the literature on the epidemiology, suggested pathogenesis, clinical presentation and treatment of this rare presentation of SLE.
Collapse
Affiliation(s)
- E Athanasopoulos
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - I Kalaitzidou
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - G Vlachaki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - S Stefanaki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - A Tzagkaraki
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - G Niotakis
- b Peadiatric Neurology Clinics, Venizeleion General Hospital , Heraklion, Crete , Greece
| | - I Tritou
- c Department of Radiology , Venizeleion General Hospital , Heraklion, Crete , Greece
| | - F Ladomenou
- a Department of Paediatrics , Venizeleion General Hospital , Heraklion, Crete , Greece
| |
Collapse
|
6
|
Sudhakar P, Tobin S, O Connor W, Kedar S. Neuro-Ophthalmic Presentation of Neuro-Sweet Disease. Neuroophthalmology 2017; 41:202-206. [PMID: 29344060 DOI: 10.1080/01658107.2017.1291687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/20/2022] Open
Abstract
Acute febrile neutrophilic dermatosis (Sweet syndrome) is a systemic inflammatory condition usually associated with autoimmune or neoplastic processes and characterised by inflammatory dermatologic lesions such as erythematous plaques and papules associated with fever and leukocytosis. Neurological and ophthalmological involvement is rare. The authors describe an unusual case of Sweet syndrome associated with microscopic polyangiitis presenting with papilloedema, anterior uveitis, and skin rash. Years later, he developed acute posterior multifocal placoid pigment epitheliopathy. Treatment with immunosuppressive medications led to a relapsing remitting course with maximum benefit from use of steroids. The authors describe the difficulties in diagnosis and treatment of this rare case.
Collapse
Affiliation(s)
- Padmaja Sudhakar
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.,Department of Ophthalmology, University of Kentucky, Lexington, Kentucky, USA
| | - Stuart Tobin
- Department of Dermatology, University of Kentucky, Lexington, Kentucky, USA
| | - William O Connor
- Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Sachin Kedar
- Department of Neurological Sciences and Stanley Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
7
|
Miyauchi T, Nishie W, Sakata M, Osawa R, Noguchi A, Shimizu H. Sweet syndrome-like eruption with prominent dermal leukocytoclasis associated with systemic lupus erythematosus. J Dermatol 2015; 42:442-3. [PMID: 25676440 DOI: 10.1111/1346-8138.12802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Toshinari Miyauchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | | | | | | | | |
Collapse
|
8
|
Hau E, Vignon Pennamen MD, Battistella M, Saussine A, Bergis M, Cavelier-Balloy B, Janier M, Cordoliani F, Bagot M, Rybojad M, Bouaziz JD. Neutrophilic skin lesions in autoimmune connective tissue diseases: nine cases and a literature review. Medicine (Baltimore) 2014; 93:e346. [PMID: 25546688 PMCID: PMC4602621 DOI: 10.1097/md.0000000000000346] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The pathophysiology of neutrophilic dermatoses (NDs) and autoimmune connective tissue diseases (AICTDs) is incompletely understood. The association between NDs and AICTDs is rare; recently, however, a distinctive subset of cutaneous lupus erythematosus (LE, the prototypical AICTD) with neutrophilic histological features has been proposed to be included in the spectrum of lupus. The aim of our study was to test the validity of such a classification. We conducted a monocentric retrospective study of 7028 AICTDs patients. Among these 7028 patients, a skin biopsy was performed in 932 cases with mainly neutrophilic infiltrate on histology in 9 cases. Combining our 9 cases and an exhaustive literature review, pyoderma gangrenosum, Sweet syndrome (n = 49), Sweet-like ND (n = 13), neutrophilic urticarial dermatosis (n = 6), palisaded neutrophilic granulomatous dermatitis (n = 12), and histiocytoid neutrophilic dermatitis (n = 2) were likely to occur both in AICTDs and autoinflammatory diseases. Other NDs were specifically encountered in AICTDs: bullous LE (n = 71), amicrobial pustulosis of the folds (n = 28), autoimmunity-related ND (n = 24), ND resembling erythema gyratum repens (n = 1), and neutrophilic annular erythema (n = 1). The improvement of AICTDS neutrophilic lesions under neutrophil targeting therapy suggests possible common physiopathological pathways between NDs and AICTDs.
Collapse
Affiliation(s)
- Estelle Hau
- From the Dermatology Department (EH, AS, MJ, FC, MarB, MR, JDB) and Pathology Department (MDVP, MaxB, BCB), Paris Diderot University, Sorbonne Paris Cité, AP-HP, Saint Louis Hospital, Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
González-Moreno J, Ruíz-Ruigomez M, Callejas Rubio JL, Ríos Fernández R, Ortego Centeno N. Pyoderma gangrenosum and systemic lupus erythematosus: a report of five cases and review of the literature. Lupus 2014; 24:130-7. [PMID: 25199808 DOI: 10.1177/0961203314550227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etiopathogenesis of PG is still not well understood. PG is part of the spectrum of the neutrophilic dermatoses and it has been proposed as a prototype of cutaneous autoinflammatory disease. PG usually has a good outcome under immunosuppressive treatment. Although PG has been associated with several systemic diseases, it has rarely been reported in association with systemic lupus erythematosus (SLE). In this article we report five cases of SLE-related PG and review the literature. Our findings support the possible relationship between active SLE and PG, although the mechanism remains unclear. Clinical manifestations, used treatments and outcomes of SLE-related PG do not differ from the described for the general population.
Collapse
Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Spain Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - M Ruíz-Ruigomez
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - J L Callejas Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - R Ríos Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| | - N Ortego Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Spain
| |
Collapse
|
10
|
Büyükkaragöz B, Koçak M, Erdeniz EH, Yılmaz AÇ, Işın UU, Takcı Z, Güreşci S, Günbey S. Eight-year old male patient with painful swelling and eruptions in the legs. Turk Arch Pediatr 2014; 49:171-4. [PMID: 26078657 DOI: 10.5152/tpa.2014.1707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/10/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Bahar Büyükkaragöz
- Unit of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Mesut Koçak
- Clinic of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | | | - Aysun Çaltık Yılmaz
- Unit of Pediatric Nephrology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Uğur Ufuk Işın
- Clinic of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Zennure Takcı
- Unit of Dermatology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Servet Güreşci
- Unit of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Sacit Günbey
- Clinic of Pediatrics, Keçiören Training and Research Hospital, Ankara, Turkey
| |
Collapse
|